PURPOSE: The study aimed to assess the average time to return to play following surgery for chronic lateral ankle instability in athletes.METHODS: A literature search was conducted (1976 to 2019) by two independent reviewers using the Medline, Embase, and Cochrane library databases. Articles were retrieved by an electronic search using individual keywords (“lateral ankle instability,” “surgery,” “operation,” “return to sport,” “return to play”) and their combinations. Studies that met the inclusion criteria were assessed for pertinent data.RESULTS: Six randomized controlled trials were included in this analysis. The mean follow-up period was 44.8 months (range, 31.8–58.1 months) in 219 patients (male, 126; female, 113). The mean age was 23.2 years (range, 18.2–28.2 years). Different criteria for returning to sports were used in each paper. In the papers included in this study, different methods and definitions were used for the postoperative recovery method for lateral ankle instability injury. The average time until return to play was 16.53 weeks.CONCLUSION: There are limitations to the application of different surgical techniques and data from different athletes for chronic lateral ankle instability. However, these results suggest that sports physicians evaluate the surgical outcome and may be utilized as reference data for informing the athletes about their time until return.
Ankle Injuries ; Ankle ; Athletes ; Female ; Follow-Up Studies ; Humans ; Methods ; Return to Sport ; Sports

The precise mechanism involved in DIC and delayed traumatic subarachnoid hemorrhage (DT-SAH) remains unclear in multiple-trauma patients. Hereby, we describe a polytraumatized patient with DIC who died due to DT-SAH. A 75-year-old female patient was admitted to our Emergency Department complaining of abdominal pain and drowsiness after a pedestrian accident. Her initial brain computerized tomography (CT) finding was negative for intracranial injury. However, her abdominal CT scan revealed a collection of retroperitoneal hematomas from internal iliac artery bleeding after a compressive pelvic fracture. This event eventually resulted in shock and DIC. An immediate angiographic embolization of the bleeding artery was performed along with transfusion and anti-thrombin III. Her vital signs were stabilized without neurological change. Fourteen hours after admission, she suddenly became comatose, and her follow-up brain CT scan revealed a dense DT-SAH along the basal cisterns with acute hydrocephalus. This event rapidly prompted brain CT angiography and digital subtraction angiography, which both confirmed the absence of any cerebrovascular abnormality. Despite emergency extraventricular drainage to reverse the hydrocephalus, the patient died three days after the trauma. This paper presents an unusual case of DT-SAH in a polytraumatized patient with DIC.
Abdominal Pain ; Aged ; Angiography ; Angiography, Digital Subtraction ; Arteries ; Brain ; Coma ; Dacarbazine ; Disseminated Intravascular Coagulation* ; Drainage ; Emergencies ; Emergency Service, Hospital ; Female ; Follow-Up Studies ; Hematoma ; Hemorrhage ; Humans ; Hydrocephalus ; Iliac Artery ; Multiple Trauma ; Shock ; Sleep Stages ; Subarachnoid Hemorrhage, Traumatic* ; Tomography, X-Ray Computed ; Vital Signs

Acute visual loss caused by an infected mucocele in an Onodi cell is extremely rare. The Onodi cell is a pneumatized posterior ethmoid cell located laterally and superiorly to the sphenoid sinus and closely related to the optic nerve. Therefore, a mucocele affecting the Onodi cell that has encroached on the adjacent sphenoid bone forming the optic canal can rarely present with visual loss. We describe a rare case of retrobulbar optic neuritis caused by an infected mucocele in the Onodi cell. A 54-year-old male complained of headache and visual loss in his right eye. A computed tomography scan and magnetic resonance image demonstrated a mucocele occupying the Onodi cell on the right side. Surgical treatment with an endoscopic sinus approach was performed, resulting in improvement of visual acuity. A lesion in an Onodi cell may be associated with ocular symptoms even if the lesion is isolated or small. Imaging studies should be considered for the differential diagnosis because early diagnosis and prompt surgical treatment for mucocele are needed for recovery of visual function.
Diagnosis, Differential ; Early Diagnosis ; Eye ; Headache ; Humans ; Magnetic Resonance Spectroscopy ; Male ; Middle Aged ; Mucocele ; Optic Nerve ; Optic Neuritis ; Sphenoid Bone ; Sphenoid Sinus ; Visual Acuity

The balloon-assisted enteroscope has been regarded as the standard device for direct visualization of deep small bowels and allows for the diagnosis and treatment of small bowel disease. At the beginning, its application was focused on the diagnosis of obscure gastrointestinal bleeding, inflammatory bowel disease, and small bowel tumor. However, the indications are being expanded to various therapeutic procedures, not only confined to bleeding control. With the expansion of the indications, the need to perform enteroscopy effectively and safely is increasing. Recent studies have been focused on the diagnostic yield, therapeutic yield, and long-term outcomes of the device. However, with the increasing number of procedures, procedural guidelines and quality indicators are also needed.
Diagnosis ; Double-Balloon Enteroscopy ; Endoscopy* ; Hemorrhage ; Inflammatory Bowel Diseases

Freiberg's disease is a osteochondrosis of a metatarsal head that is recognized as primarily a disorder of the second metatarsal. It is seen more often in girls. Pain and limitation of motion of the affected joint is the predominant clincal feature. The radiographic appearance demonstrates from osteosclerosis in the early stage to osteolysis with collapse in the later stage. Conservative therapy may take the form of rest, a stiff shoe, and even a cast support to decrease the stress across the joint. Surgical intervention may also be of benefit. Surgery have been attempted either to modify the diseae process or to salvage the situation once the metatarsophalangeal joint develops degenerative changes. Metatarsophalangeal joint instability is common cause of forefoot pain that can develop in association with a traumatic episode and inflamatory tissue disorders as well as neighboring toe deformities. The second ray is by far the most frequently involved. The diagnosis can be made by clinical observation and physical examination including drawer test. Many surgical procedures have beem recommended when conservative treatment has failed. Procedures described range from soft tissue releases and tendon trasfer to the direct plantar plate repair combined with a Weil osteotomy.
Congenital Abnormalities ; Head ; Joints ; Metatarsal Bones ; Metatarsophalangeal Joint ; Metatarsus ; Osteochondritis ; Osteochondrosis ; Osteolysis ; Osteosclerosis ; Osteotomy ; Physical Examination ; Shoes ; Tendons ; Toes

The presence of an ectopic supernumerary tooth in the nose is an uncommon phenomenon. A supernumerary tooth may be asymptomatic but must be given special attention as it has the potential to cause significant morbidity. Bilateral intranasal supernumerary teeth are an extremely rare disease entity. We report the clinical and radiologic findings of bilateral ectopic supernumerary teeth erupted from the nasal floor.
Nose ; Rare Diseases ; Tooth, Supernumerary*

PURPOSE: The purpose of this study was to develop a wellness index for workers (WIW) and examine the validity and reliability of the WIW for assessing workers' wellness. METHODS: The developmental process for the instrument included construction of a conceptual framework based on a wellness model, generation of initial items, verification of content validity, preliminary study, extraction of final items, and psychometric testing. Content validity was verified by 4 experts from occupational health nursing and wellness disciplines. The construct validity, convergent validity and discriminant validity were examined with confirmatory factor analysis. The reliability was examined with Cronbach's alpha. The participants were 494 workers from two workplaces. RESULTS: Eighteen items were selected for the final scale, and the results of the confirmatory factor analysis supported a five-factor model of wellness with acceptable model fit, and factors named as physical . emotional . social . intellectual . occupational wellness. The convergent and discriminant validity were also supported. The Cronbach's alpha coefficient was .91. CONCLUSION: The results indicate that the WIW is a valid and reliable instrument to comprehensively assess workers' wellness, and to provide basic directions for developing workplace wellness program.
Adult ; Female ; *Health Promotion ; Health Status ; Humans ; Male ; Middle Aged ; *Occupational Health Services ; Program Development ; Program Evaluation ; Psychometrics ; Surveys and Questionnaires ; Workplace

Background: Tibial tuberosity transposition (TTT) causes caudalization of the patellar ligament insertion in canine medial patellar luxation, which can lead to increases in patellofemoral contact pressure. Objectives: The purpose of this study is to confirm the effect of patellofemoral contact mechanics after craniolateral and caudolateral transposition of tibial tuberosity in normal canine hindlimbs. Methods: Craniolateral and caudolateral transposition of tibial tuberosity was performed in 5 specimens, respectively. The pressure was measured in the specimen before TTT, and then in the same specimen after TTT. In this process, data was obtained in 10 specimens. The measurement results were output as visualization data through the manufacturer's software and numerical data through spreadsheet. Based on these 2 data and the anatomical structure of the patellofemoral joint (PFJ) surface, whole measurement area was analysed by dividing into medial, lateral and central area. Results: In craniolateralization of tibial tuberosity, total, medial, central contact pressure was decreased and lateral contact pressure was not statistically changed lateral contact pressure than normal PFJ. In caudolateralization of tibial tuberosity, total, lateral contact pressure was increased and medial contact pressure was not statistically changed than normal PFJ. Although not statistically significant changed, central contact pressure in caudolateralization of tibial tuberosity was increased in all 5 specimens. Conclusions These results imply that traditional TTT, prone to caudal shift of patellar tendon, can increase retropatellar pressure may lead to various complications and diseases of the stifle joint.

Objectives: We evaluated the efficacy of a medial arthroscopic approach to the coxofemoral joint of dogs by analyzing the joint visible area and performing a safety analysis. Methods: Arthroscopic approaches to the coxofemoral joint were made in five cadavers using a traditional (dorsal) and novel (medial) approach. Three observers scored the visible area of images and videos of the acetabulum and femur. A safety analysis was performed via dissection of the medial hind limb. The distance between neurovascular structures and arthroscopic portals was measured. Results: The acetabulum was more visible in the dorsal than in the medial approach, with mean visualization scores of 16 ± 0.00 and 11.83 ± 1.26, respectively. The medioventral side of the femur was significantly more visible in the medial than in the dorsal approach, with mean visualization scores of 3.9 ± 0.99 and 6.93 ± 0.58, respectively. Safety analysis confirmed the medial portal site was safe, provided that the surgeon has comprehensive knowledge of the joint. The minimum distance from the arthroscopic medial portals to the nearest neurovascular structures was 2.5 mm. Conclusions A medial arthroscopic approach to the canine coxofemoral joint has potential clinical application. Dorsal and medial approaches differ significantly and have distinct purposes. The medial approach is useful to access the ventromedial joint, making it an eligible diagnostic method for an arthroscopic evaluation of this area.

Abstract: Ten cadavers were studied to compare the accessibility of cervical vertebral canal with conventional standard ventral slot and modified slanted ventral slot. One group performed standard ventral slot procedures at the C3-4, C5-6. The other group performed modified slanted ventral slot with inverted cone technique procedures at the C3-4, C5-6 computed tomography was performed before and after surgery. The accessibility of cervical vertebral canal with conventional standard ventral slot and modified slanted ventral slot using computed tomography in C3-4 and C5-6 intervertebral space was compared. Although smaller ostectomy was performed in the modified slanted ventral slot, some lesions were more accessible but limitations were obvious in C3-4 and C5-6 intervertebral disk space. After the disc material has been identified through accurate preoperative diagnostic imaging, less morbidity and complications can be expected if the appropriate surgical method is selected based on the lesion of compression.